La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.
Drs datta 9th august 2012
type 1 with obesity. Deficiency of insulin plus
National Institute for Health and Clinical Excellence (NICE): T2D treatment algorithm1 Consider SU if: HbA1c ≥6.5% after lifestyle intervention Consider substituting Consider adding DPP-4 or TZD for SU if: DPP-4 or TZD if: Consider adding sitagliptin or TZD: •Instead of insulin if insulin is unacceptable Consider adding exenatide to MET and SU if Increase insulin dose and intensify regimen. Consider adding pioglitazone if:
• A TZD has previously had marked effect or blood
glucose control is inadequate with high-dose insulin
MET = metformin, SU = sulphonylureas, TZD = thiazolidinedione, DPP-4= dipeptidyl peptidase-4 inhibitor
1. Adapted from: National Institute for Health and Clinical Excellence. Clinical Guideline 87. Type 2 diabetes - newer
agents (a partial update of CG66): quick reference guide. Scottish Intercollegiate Guidelines Network (SIGN): T2D treatment algorithm1 1st LINE OPTIONS in addition to lifestyle measures; START ONE OF Usual approach Sulphonylurea* (SU) Alternative approach Metformin (MET)
• If intolerant to metformin• If weight loss/osmotic symptoms
* Continue medication if EITHER individualised target achieved OR HbA1c falls >0.5% (5.5 mmol/mol) in 3-6 2nd LINE OPTIONS in addition to lifestyle measu
res, adherence to medication and dose optimisation; ADD ONE OF
Thiazolidinedione* DPP-4 inhibitor*
• If hypos a concern (e.g. driving, occupational hazards, at risk of
• If hypos a concern (e.g. driving, occupational hazards, at risk of
falls) and if no congestive heart failure
3rd LINE OPTIONS in addition to lifestyle measures, adherence to medication and dose optimisation; ADD OR SUBSTITUTE WITH ONE OF ORAL (continue MET/SU if tolerated) INJECTABLE (if willing to self inject; continue MET/SU if tolerated) Thiazolidinedione* DPP-4 inhibitor* Insulin* (inject before bed) GLP-1 agonists*
• If osmotic symptoms/rising HbA1c; NPH insulin initially
• If hypos a concern, use basal analogue
• Add prandial insulin with time if required
DPP-4= dipeptidyl peptidase-4 inhibitor; GLP-1 = glucagon-like peptide 1
Adapted from: Scottish Intercollegiate Guidelines Network. Management of diabetes: a national clinical guideline. March 2010. Prescribers
should refer to the British National Formularh Medicines C
updated guidance on licensed indications, full contraindications and monitoring requirements.
• Food Plan - Dietitian with knowledge of
for 3 months unless glucose very highreinforced by dietitian
If you add sulphonylurea or insulin the weight will go up and appetite will be
- maybe but TOO Much. Portion size. Smaller plate
. I can not exercise because of back/heart
- exercise does not burn many calories- c
- Rubbish obese have higher BMR than normal weight
.v.v.rare metabolic problems associated with obesity
only gland that’s wrong is ………….
lter eating habits permanently – food plan/life style
ifficult – food is pleasurable + social
-eating is a habit. Stop eating when full. LEAVE FOOD
. Never tell obese T2D to snack between meals/ have a
. Anticipate exercise and take less medication before it
500mg with main meal for two weeks then 500mg BD etc
• Try Metformin SR if bowel intolerant
• If not to target send to NASTY dietitian!
• Check eGFR reduce dose if renal impairment
esponse v variable better if not diagnosed too
ay need to add in prandial regulator with
• Food Plan –isocaloric – restrict fast
• Consider sulphonylureas – gliclazide
• Can still use metformin – for insulin
• Add basal long acting insulin if fasting glucose is
97 11 17.586 10 15.575 9 13.564 8 11.553 7 9.5
Progetti di ricerca in corso nell’ U.O. di Virologia Direttore: Prof. Ceccherini-Nelli Luca INTRODUZIONE Il virus erpetico ottavo umano (HHV-8), noto anche come virus erpetico associato al sarcoma di Kaposi (KSHV) è stato isolato per la prima volta nel 1994 da una biopsia di un sarcoma di Kaposi (SK) associato ad AIDS. E’ un virus a DNA a doppio filamento dotato di pericapside e con sim